Australian and international literature provides strong evidence that intravenous use of psychostimulants increases the harms experienced by users, including heightening the risk of blood-borne virus (BBV) infection. The few Australian studies that include women who inject psychostimulants identify street-based sex work as the main method of income generation and highlight the harms that result from combining these practices. However, there has been little exploration into the way these practices are shaped by the environments in which they occur or the ways in which women manage these harms. This thesis aims to provide an in-depth exploration of the daily lives of women who inject psychostimulants and engage in street-based sex work in Kings Cross, Sydney. Over 18 months between 2005 and 2007, the author conducted ethnographic fieldwork with women who injected psychostimulants and engaged in street-based sex work in Kings Cross, Sydney. Data sources included observations recorded as fieldnotes and transcripts of in-depth interviews with 12 women. Thematic analysis of the data was employed with particular attention to the women???s shared narratives. Key findings of the thesis were that 1) the Kings Cross environment plays a prominent role in shaping the lives of women, their psychostimulant injecting and street-based sex work practices; 2) psychostimulant injecting reinforces the opportunistic nature of street-based sex work as the primary method of income generating for women, restricting the development of occupational norms; 3) synergies exist between the drug and sex markets in Kings Cross, increasing the harms associated with both injecting and street-based sex work practices; 4) public health messages relating to sharing of injecting equipment and condom use fail to account for contextually driven decision-making and risk prioritising; 5) women develop lay epidemiological understandings as they attempt to reconcile the public health messages with the lived reality. The value of these findings is in the insights they provide into the everyday lives of these women in Kings Cross that have not been documented previously and their potential for informing ???bottom-up??? rather than ???top down??? approaches to future policy, practice and research.

No description available.

Bakgrund: Personer som injicerar droger riskerar att drabbas av allvarliga infektioner. Tidigare studier har visat att personal som möter personer i risk inte har tillräckligt med kunskap för att erbjuda hälsofrämjande insatser. Syfte:Att kartlägga personalens kunskap om infektioner som kan drabba personer som injicerar droger,samt undersöka om utbildnings intervention ökar personalens kunskap och motivation till preventiva samtal. Metod:Totalt genomfördes fem utbildningar med 26 deltagare från psykiatri-, och infektionsavdelning, samt ungdomsmottagning. Studien genomfördes med enkät före och en månad efter utbildning. Enkäten innehöll kunskapsfrågor och frågor om erfarenhet av preventionssamtal med personer i risk. Resultat:Studien visade att personalen saknade tillräcklig kunskap om smitta vid injektion av droger och att personer i risk inte i tillräcklig omfattning erbjöds information och stöd. Innan utbildning skulle enbart 60 % av personalen samtala om smitta vid injektion av droger om de fick frågor av personer i risk. Hinder för samtal uppgavs vara brist på kunskap och osäkerhet på hur frågorna skulle tas emot vid samtal. Personalens upplevda och faktiska kunskap visade på en signifikant förbättring efter utbildningsinterventionen (p&lt;0,001). Utbildningen upplevdes som relevant och 80 % av deltagarna önskade ytterligare utbildning i form av föreläsningar på arbetsplatsen och handledning av sakkunnig. Konklusion:För att kunna erbjuda personer som injicerar droger hälsofrämjande insatserkrävs att personal har tillgång till anpassad utbildningoch aktivt stödutifrån verksamhetensbehov / Background:People who inject drugs are at risk of contracting severe infections. Previous studies have shown that personnel meeting people at risk often lack sufficient knowledge to offer health promotion measures. Aims:This study aimed to investigate knowledge among personnel about infectious diseases contracted due to injecting drugs and determine whether educational intervention can increase knowledge and motivation for preventive communication. Methods:We administered a total of five courses to 26 healthcare workers employed in an infectious diseases department, psychiatric clinic, and youth counseling clinic. The study was conducted with questionnaires before and one month after completing the courses. The questionnaires included questions about disease facts, and workers’ experience regarding preventive conversations with people at risk. Results:The study revealed that respondent slacked sufficient knowledge about infections associated with injecting drugs, and that people at risk did not receive adequate information and support. Before education, only 60% of respondents would consider talking about infections contracted while injecting drugs if they got questions by persons at risk. Barriers to addressing such questions included lack of knowledge,and uncertainty about how the questions would be received. After the educational intervention, respondents perceived a significant improvement of knowledge (p&lt;0,001). They perceived the coursesas relevant,and 80% of participants wanted more lectures and expert guidance in the workplace. Conclusion:Providing health promotion to persons who inject drugs requires appropriate educationfor personnel,as well as active support adapted to their needs. / <p>ISBN 978-91-86739-82-9</p>

Drug injection is an increasingly important risk factor in the transmission of blood-borne pathogens, including the hepatitis C virus (HCV) and human immunodeficiency virus (HIV). The purpose of the study was to examine the influence of social network factors on HCV and HIV. The study was grounded in social network theory and sought to determine whether social network characteristics affect high-risk sexual and drug injection behavior as well as self-reported HIV and HCV status. The study design was a quantitative cross-sectional survey. A total of 181 participants in a needle exchange program completed a survey in Spanish assessing individual drug and sex risk practices as well as gathering information to describe the characteristics of participants' personal networks from an egocentric perspective. General estimating equation techniques were used to analyze the data. Results showed that only social network size was related to risky sexual behavior. Injecting risk behaviors were only impacted by personal network exposures, measured by the average number of years network members had injected. HIV self-reported serum status was correlated with trust, closeness, and number of family members named among the closest 5 network members. Last, HCV self-reported serum status was only related to the years that network members had been injecting drugs. This study has implications for positive social change in that public health practitioners may gain a better understanding of the social network characteristics associated with high-risk behaviors of those infected with HCV and HIV in order to develop health promotion programs to lower infections and mortality.

There is increasing concern about hepatitis C virus (HCV) and potential HIV transmission among ethnic Vietnamese injecting drug users (IDUs) in Australia. To date ethnic and cultural differences in vulnerability to blood-borne viruses (BBV) have received little attention and few studies have attempted to explore the role of cultural beliefs and values in influencing injection risk behaviour. This study aimed to systematically explore the cultural beliefs and behavioural practices that appear to place ethnic Vietnamese IDUs at increased risk of BBV infection, identify barriers to this group accessing health and preventive programs, and document antibody HIV and HCV prevalence and associated risk behaviours. The first component of the research consisted of an ethnographic study designed to explore underlying explanatory models of health and illness employed by Vietnamese IDUs and identify cultural influences on risk behaviours and vulnerability to BBVs. These data were subsequently used to inform the development of the instrument used in the second component ??? a cross-sectional survey and collection of capillary blood samples designed to assess risk behaviours and antibody HIV and antibody HCV prevalence. Analysis of data from both components indicates that cultural beliefs and practices influence risk-taking and health-seeking behaviours and suggests pathways through which this influence occurs. Relevant cultural characteristics include those pertaining to spiritual and religious beliefs, the role of the family and traditional Vietnamese family values, cultural scripts of self-control and stoicism, the importance of ???face??? and non-confrontational relationships, trust and obligation, and a reluctance to discuss problems with outsiders. Vulnerability to BBVs is influenced by these cultural characteristics, together with Vietnamese IDUs??? perceptions of risk, knowledge about HIV and HCV, and situational and environmental factors. Main factors contributing to the under-utilisation of health services include the use of self-managed care practices, ambivalence surrounding Western medicine, long waiting times, concerns in relation to confidentiality, stigmatisation of drug use, and limited knowledge of BBVs. The data indicate a need for interventions based on understanding of culturally specific meanings and contexts of health, illness and risk in order to better meet the needs of this vulnerable group.

There is increasing concern about hepatitis C virus (HCV) and potential HIV transmission among ethnic Vietnamese injecting drug users (IDUs) in Australia. To date ethnic and cultural differences in vulnerability to blood-borne viruses (BBV) have received little attention and few studies have attempted to explore the role of cultural beliefs and values in influencing injection risk behaviour. This study aimed to systematically explore the cultural beliefs and behavioural practices that appear to place ethnic Vietnamese IDUs at increased risk of BBV infection, identify barriers to this group accessing health and preventive programs, and document antibody HIV and HCV prevalence and associated risk behaviours. The first component of the research consisted of an ethnographic study designed to explore underlying explanatory models of health and illness employed by Vietnamese IDUs and identify cultural influences on risk behaviours and vulnerability to BBVs. These data were subsequently used to inform the development of the instrument used in the second component ??? a cross-sectional survey and collection of capillary blood samples designed to assess risk behaviours and antibody HIV and antibody HCV prevalence. Analysis of data from both components indicates that cultural beliefs and practices influence risk-taking and health-seeking behaviours and suggests pathways through which this influence occurs. Relevant cultural characteristics include those pertaining to spiritual and religious beliefs, the role of the family and traditional Vietnamese family values, cultural scripts of self-control and stoicism, the importance of ???face??? and non-confrontational relationships, trust and obligation, and a reluctance to discuss problems with outsiders. Vulnerability to BBVs is influenced by these cultural characteristics, together with Vietnamese IDUs??? perceptions of risk, knowledge about HIV and HCV, and situational and environmental factors. Main factors contributing to the under-utilisation of health services include the use of self-managed care practices, ambivalence surrounding Western medicine, long waiting times, concerns in relation to confidentiality, stigmatisation of drug use, and limited knowledge of BBVs. The data indicate a need for interventions based on understanding of culturally specific meanings and contexts of health, illness and risk in order to better meet the needs of this vulnerable group.

Background: Injecting drug users (IDUs) represent considerable group of patients infected with hepatitis C virus (HCV). HCV treatment is an effective tool for reduction of HCV transmissions among IDUs. Nevertheless treatment rate among IDUs is rather insufficient. Treatment uptake, provision and adherence as well as its efficacy in IDUs are determined by number of specific factors. Aims: Mapping an extent of the provision of HCV treatment to IDUs in the Czech Republic, rules and practices for the admission of IDUs into HCV treatment and its provision, describing relevant factors related to drug use. Material and methods: From January to March 2011, a questionnaire survey among centres for treatment of viral hepatitis in the Czech Republic was conducted. 76 identified centres were addressed, of which 45 (59%) responded, and 40 (53%) filled in an online questionnaire. Results: Estimated number of centres treated HCV with combination of pegylated interferon α and ribavirin in the Czech Republic in 2010 was 61, 39 of them treated IDUs. Estimated 780 persons were treated, of whom 370 were (mostly ex-) IDUs. Reported treatment uptake in IDUs was 60% on average (range 0-90%). Treatment is completed by 80% of IDUs on average (0-100%) according to clinicians. Most clinicians reported no difference in the treatment...

<p>   </p> <p>Subcutaneous injection is a biotherapeutic drug delivery method that is currently growing due to low cost, better patient compliance, minimally invasive, and the convenience that it can be done at home. Common injection sites for subcutaneous injection include the upper outer arms, abdomen, buttocks, and upper outer thigh. Heterogeneity of the tissue exists between and within each of these locations. The subcutaneous tissue space is made up of adipose tissue, proteins, collagen, and blood vessels and each of these components has an impact on the mass transport of the injected biotherapeutics and how they are absorbed into the vascular system and then distributed to the body. The current methods used to model the subcutaneous tissue space are either very expensive and not feasible for multiple repetitions, cannot incorporate fibrillar proteins or cellular components, or model a more homogeneous tissue space. These limitations do not allow for these models to accurately represent the subcutaneous tissue space. The engineering objective for this project was to develop a platform with tunable matrix architecture and biochemical composition for evaluating mass transport. This project utilizes collagen and the primary matrix due to the large abundance of collagen in the body.  We explored the effects that a change in polymerization temperature of the collagen and collagen concentration had on the fiber architecture and pore diameter. The results showed that higher polymerization temperatures of the collagen gels resulted in smaller fiber and pore diameters and an increase in concentration resulted in an increase in fiber volume fraction and a decrease in pore diameter. Fibronectin (FN) and hyaluronic acid (HA) were added to the collagen gels to analyze the impact on the structure of collagen gels with a change in polymerization temperature and collagen concentration. The addition of FN did not strongly alter the collagen fiber architecture between polymerization temperatures and collagen concentrations. Through staining and imaging, we saw an aggregation of FN around the collagen fibrils due to their opposing charges causing them to bind. The addition of HA had moderate impact on collagen fiber architecture across all polymerization temperatures and between collagen concentrations. The collagen + FN gels were used for the mass transport study. The results showed that there was little to no difference between the recovery rates of macromolecules of different charges and size between the collagen and collagen + FN gels, indicating that the transport of molecules through both of the collagen gels was impacted by a steric effect rather than an effect in charge.</p> <p>  </p>

La majorité des personnes utilisatrices de drogues par injection (PUDI) contracteront le virus de l’hépatite C (VHC), les mettant à risque accru de complications hépatiques graves et parfois mortelles. Les comportements les plus risqués pour l’acquisition du VHC incluent le partage de matériel d’injection et l’injection à haute fréquence. Un facteur jusqu’ici négligé dans l’évaluation du risque de VHC est l’aspect dynamique de l’injection, c.-à-d. la manière dont elle varie dans le temps, incluant l’effet des périodes sans injection et celui des changements dans la fréquence d’injection. On reconnaît également l’effet délétère que l’instabilité résidentielle peut avoir sur le risque de VHC, bien que les mécanismes sous-jacents soient mal compris. Cette thèse s’intéresse à l’effet des variations temporelles de l’injection sur le risque de VHC, et à la manière dont la fréquence d’injection évolue en concomitance avec les conditions résidentielles dans le temps, afin d’aider au développement de nouvelles stratégies de prévention du VHC. Les données ont été recueillies entre mars 2011 et juin 2016 dans la Hepatitis Cohort, une cohorte de PUDI suivies trimestriellement à Montréal, au Québec. Une première analyse a évalué l’effet des périodes sans injection de trois mois ou moins sur le risque de VHC sur 916 personnes-années de suivi, par régression de Cox (N=372). Celle-ci suggère que les PUDI présentant des périodes sans injection courtes (3/3 mois sans injection) et sporadiques (1/3 ou 2/3 mois sans injection) sont respectivement 76% et 44% moins à risque de VHC que celles s’injectant de manière persistante (0/3 mois sans injection). Une deuxième analyse a utilisé la modélisation de trajectoires fondée sur le groupement pour identifier cinq types distincts de trajectoires de fréquence d’injection suivies sur une année, lesquels ont ensuite été comparés en termes d’incidence du VHC sur des périodes de suivi allant de 71 à 355 personnes-années (N=386). Les résultats suggèrent que les PUDI dont la fréquence reste élevée (injection fréquente) ou change dans le temps (croissante, décroissante) sont à plus haut risque de VHC que celles s’injectant à basse fréquence (sporadique, peu fréquente). Une dernière analyse a identifié trois types de trajectoires de stabilité résidentielle suivies sur un an (persistance, déclin, amélioration; N=386), lesquels ont été évalués en association avec les trajectoires de fréquence d’injection suivies simultanément. Les résultats suggèrent qu’il existe un lien entre l’amélioration des conditions résidentielles et la diminution de la fréquence d’injection, mais aussi que la probabilité d’injection à fréquence croissante est plus élevée chez les PUDI maintenant des conditions résidentielles stables que celles chez qui elles s’améliorent. Collectivement, les résultats ont de nombreuses implications en termes de prévention du VHC. Cliniquement, l’instabilité de la fréquence d’injection semble être un facteur de risque à monitorer régulièrement. En termes de santé publique, les interventions favorisant l’engagement dans des périodes sans injection ou le maintien d’une basse fréquence d’injection pourraient être prometteuses. Enfin, les stratégies visant l’amélioration des conditions résidentielles pourraient éventuellement aider les PUDI à réduire leur fréquence d’injection, mais être insuffisantes pour maintenir celle-ci à basse fréquence une fois la stabilité atteinte. / The majority of people who inject drugs (PWID) will become infected with hepatitis C virus (HCV), placing them at risk of serious and sometimes fatal liver complications. Injecting behaviours with higher risk of HCV transmission include injecting equipment sharing and high frequency injecting. One factor that has been overlooked when assessing HCV acquisition risk is the dynamic aspect of drug injecting, i.e., how drug injecting varies over time, including the role of injecting cessation episodes and that of changes in injecting frequency. Moreover, there is growing recognition of the deleterious effect unstable housing can have on HCV acquisition risk, although the underlying mechanisms are not yet fully understood. This thesis examines how temporal variations in drug injecting relate to HCV acquisition risk and further explores how housing conditions and injecting frequency evolve together over time, for the purposes of contributing to the development of novel HCV prevention strategies. Data were collected between March 2011 and June 2016 in the Hepatitis Cohort, a prospective cohort study of PWID interviewed and tested for HCV infection at three-monthly intervals in Montréal, Québec. A first analysis examined the effect of injecting cessation episodes of three months or less on the risk of contracting HCV during 916 person-years of follow-up, using Cox regression (N=372). Results suggest that PWID with short injecting cessation episodes (3/3 months without injecting) or sporadic injecting cessation episodes (1/3 or 2/3 months without injecting) are 76% and 44% less at risk of contracting HCV than those with persistent injecting (0/3 months without injecting), respectively. A second analysis used group-based trajectory modeling to identify five distinct types of one-year injecting frequency trajectories and compared these in terms of HCV incidence over follow-up periods ranging from 71 to 355 person-years (N=386). Findings suggest that PWID injecting with consistently high frequencies (frequent) or time-varying frequencies (increasing, decreasing) are at greater HCV acquisition risk compared with those maintaining low injecting frequencies (sporadic, infrequent). Finally, a third analysis identified three types of one-year housing stability trajectories (sustained, declining, improving) and examined their associations with concomitant injecting frequency trajectories (N=386). Findings suggest an association between improving housing stability and decreasing injecting frequency, but also a higher probability of increasing injecting frequency among PWID who maintain housing stability compared to those that improve it. Collectively, these findings have numerous implications for HCV prevention. Clinically, instability in injecting frequency appears to be a risk factor that should be monitored regularly. From a public health perspective, interventions that promote engagement in injecting cessation episodes or maintenance of low injecting frequency may be promising. Finally, strategies aimed to improve housing stability may help PWID to decrease their injecting frequency but may not be sufficient to help them maintain low injecting frequencies once housing stability is achieved.